原发性醛固酮增多症功能分型诊断中醛固酮分泌优势侧的相关因素分析及预测模型建立  

The analysis of related factors on the unilateral aldosterone secretion in the functional diagnosis of primary aldosteronism and establishment of a predictive model

作　　者：朱师禹 林乐德 郭一丁 陈涛[1] 沈思魁 刘志洪[1] 朱育春[1] 周亮[1] Zhu Shiyu;Lin Lede;Guo Yiding;Chen Tao;Shen Sikui;Liu Zhihong;Zhu Yuchun;Zhou Liang(Department of Urology,Institute of Urology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院泌尿外科,泌尿外科研究所,成都610041

出　　处：《中华医学杂志》2021年第34期2667-2673,共7页National Medical Journal of China

摘　　要：目的探究原发性醛固酮增多症(PA)患者醛固酮分泌是否存在优势侧的相关因素及构建预测模型。方法回顾性分析2016年4月至2020年9月在四川大学华西医院泌尿外科诊断为PA患者的临床资料。依据肾上腺增强CT结果分为:无结节组(双侧肾上腺均未见病变,仅单侧肾上腺增生增粗或双侧肾上腺增生增粗改变)、单侧结节组(单侧肾上腺结节改变,且对侧肾上腺增生增粗或未见异常)以及双侧结节组(双侧肾上腺呈结节样改变)。采用二元logistic回归模型分析醛固酮分泌是否存在优势侧和CT影像与肾上腺静脉采血(AVS)判定优势侧结果一致的相关因素,同时绘制预测模型的受试者工作特征(ROC)曲线和列线图。结果纳入PA患者共237例,其中男118例、女119例,中位年龄39岁,体质指数(BMI)(25.2±3.5)kg/m^(2),影像学提示直径≥1 cm结节157例(66.2%);无结节组32例,单侧结节组183例,双侧结节组22例。在所有PA患者中,多因素logistic回归模型分析结果显示,年龄(OR=0.876,P<0.001)、血钾浓度(OR=0.430,P=0.004)、是否具有典型影像学表现(OR=2.202,P=0.035)为具有优势侧的相关因素。在单侧结节组中,多因素分析提示年龄(OR=0.900,P<0.001)、血浆醛固酮浓度(PAC)(OR=1.050,P=0.018)、典型影像学表现(OR=2.637,P=0.025)为具有优势侧的相关因素;肾上腺CT优势侧判断与AVS的结果一致性仅50.2%,而年龄(OR=0.954,P=0.001)、BMI(OR=0.893,P=0.024)、PAC(OR=1.043,P=0.011)三者是AVS与CT判定结果一致的相关因素,预测模型的ROC曲线cut-off值为0.43,灵敏度56.3%,特异度86.7%,ROC曲线下面积0.742。结论年龄是PA亚型诊断中重要的预测因素,推荐依据影像学结果分为不同亚组进行临床决策。CT无明显病变或双侧病变PA患者,应尽可能行AVS明确PA功能分型诊断。Objective To explore related factors associated with unilateral aldosterone secretion of patients with primary aldosteronism(PA)and construct a predictive model.Methods The clinical data of patients who were diagnosed as PA in West China Hospital from April 2016 to September 2020 was analyzed retrospectively.According to the results of the adrenal enhancement CT,patients were divided into 3 groups,namely non-nodular group with no bilateral adrenal glands lesions,only with unilateral adrenal hyperplasia or bilateral adrenal hyperplasia,unilateral nodule group with unilateral adrenal nodules and the contralateral adrenal glands with hyperplasia or not,and bilateral nodules group with nodules in both adrenal glands.Regarding the related factors of dominant side of aldosterone secretion,univariate analysis and binary logistic regression were used.Receiver operating characteristic curve and nomogram were used to evaluate the diagnostic performance of regression models.Results A total of 237 patients with PA were included,of which,118 males and 119 females,the median age was 39 years,and the body mass index(BMI)was(25.2±3.5)kg/m^(2).There were 157(66.2%)of 237 patients with typical imaging findings.There were 32 cases in no-nodular group,183 cases in unilateral nodule group,and 22 cases in bilateral nodules group.Multivariate analysis showed that age(OR=0.876,P<0.001),blood potassium concentration(OR=0.430,P=0.004),and typical imaging findings(OR=2.202,P=0.035)were associated with unilateral aldosterone secretion.As for unilateral nodule group,multivariate analysis showed that age(OR=0.900,P<0.001),plasma aldosteronism concentration(PAC)(OR=1.050,P=0.018),and typical imaging findings(OR=2.637,P=0.025)were associated with unilateral aldosterone secretion.The agreement rate between the dominant side of the adrenal CT and AVS was only 50.2%.Multivariate analysis showed that age(OR=0.954,P=0.001),BMI(OR=0.893,P=0.024)and PAC(OR=1.043,P=0.011)were independently associated with concordance between AVS and CT.The cut-off val

关 键 词：醛固酮增多症 肾上腺静脉采血 电子计算机断层扫描 

分 类 号：R586.24[医药卫生—内分泌]